"It's not unusual for eating disorders and OCD to occur together," Dr. Weltzin explained. "To date, however, there has been little data regarding the best methods to treat these complex cases. At Rogers, we specialize in the treatment of both disorders and typically evaluate for comorbidity at admission. Our residential treatment program has been developed with a cognitive-behavioral approach for patients with both OCD and an eating disorder. This outcome study confirms that simultaneous treatment is an effective strategy for treating complex cases."

Research Highlights

To address the gap in data for treatment of complex cases where patients have co-occurring eating disorders and OCD, the study was developed to see how these patients would benefit from a multi-modal program. The hospital's residential treatment program used a cognitive-behavioral approach for patients, integrating standard exposure and response prevention (ERP) for OCD in treatment that was specifically adapted for eating disorder pathology. Patients also received a supervised eating plan, medication management and social support. Of the patients admitted to the program between 2006 and 2011, 56 completed all the study measures at admission and discharge, and all showed improvement in the severity of OCD, eating disorders and depression. Included in the study were patients who had not adequately responded to outpatient treatment.

"The results of this study are exciting," Dr. Riemann said. "What differs in this program is the development of a menu plan based on the hierarchy of feared situations and the manner in which the therapist helps patients face these situations in graduated steps of increasing difficulty. Although this may sound a bit like the standard introduction of challenge foods to the patient, it is unique in the detail of rated food fears and how the fear hierarchy shaped the menu plan. This way of introducing foods more closely resembles ERP rather than the standard CBT used for eating disorders. The results further substantiate the belief that many disorders overlap with others and that it's imperative to treat all of them simultaneously to achieve a truly effective recovery."

An internationally recognized expert in the assessment and treatment of OCD and other anxiety disorders, Dr. Riemann leads a staff of behavioral specialists who are trained to utilize both CBT and ERP as part of individual treatment plans. He added that one of the keys to this program was the use of ERP techniques to treat both OCD and pathological eating fears and behaviors. As part of the study's treatment, therapists helped patients generate a hierarchy of situations that triggered anxiety or distress. Then, they helped patients face the situations through exposures so that they would grow accustomed to the various scenarios and diminish anxiety. Patients were also asked to stop the behaviors and rituals (response prevention) to break the connection with those situations. By using these methods, patients began to recognize their irrational beliefs and work through them. ERP procedures also addressed eating pathology, incorporating a menu plan that was consistent with the ERP hierarchy, thereby further conditioning the patient to the various foods/behaviors that created the stress.